Natural history of recurrent and residual stenosis after carotid endarterectomy: Implications for postoperative surveillance and surgical management

J. J. Ricotta, M. S. O'Brien, J. A. DeWeese, D. S. Sumner, A. Aburahma, W. D. Turnipseed, Michael Dalsing

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Background. Noninvasive surveillance of patients after carotid endarterectomy is practiced routinely to detect recurrent stenoses. Many authors advocate repair of asymptomatic severe stenoses so detected. The likelihood of these lesions causing neurologic symptoms is unknown. Our aims were to (1) define the incidence of lesions, (2) determine the frequency of associated neurologic symptoms, and (3) identify patient-dependent factors that might predict restenosis. Methods. Data on the status of 449 carotid arteries after endarterectomy were reviewed. The number of recurrent and residual severe (≥80%) stenoses was identified. Interval to development of symptoms was determined by life-table analysis. Patient-dependent factors (age, gender, smoking, diabetes, and patch closure) were evaluated by univariate and multivariate analysis to identify possible associations with severe lesions. Results. Severe (≥80%) stenoses were seen in 35 patients (7.9%). Residual lesions were seen in 17 cases (eight occlusions and nine stenoses); recurrent lesions were identified in 18 patients (3.9%). Symptoms developed in five cases (14%) (one residual and four recurrent) 35, 48, 68, 98, and 103 months after surgery. The likelihood of developing symptoms associated with stenosis at 5 years was 6%. No factors correlated with residual stenosis. Age less than 60 years, female gender, primary closure, and absence of diabetes were more common in patients with recurrent lesions. Conclusions. Severe lesions can be found after carotid endarterectomy in at least 8% of patients and consist of residual defects, as well as recurrent stenoses. Recurrent lesions are more common in specific patient subgroups. These lesions are stable for long periods and the majority remain asymptomatic. Operation is not indicated unless symptoms develop in these patients. Intraoperative completion evaluation may be indicated to reduce the incidence of residual disease. Early noninvasive evaluation is useful as a quality-control measure. Repeated surveillance may provide data on the course of restenosis or contralateral disease progression but is of limited clinical benefit.

Original languageEnglish (US)
Pages (from-to)656-663
Number of pages8
JournalSurgery
Volume112
Issue number4
StatePublished - 1992
Externally publishedYes

Fingerprint

Carotid Endarterectomy
Natural History
Pathologic Constriction
Neurologic Manifestations
Endarterectomy
Life Tables
Age Factors
Incidence
Carotid Arteries
Quality Control
Disease Progression
Multivariate Analysis
Smoking

ASJC Scopus subject areas

  • Surgery

Cite this

Ricotta, J. J., O'Brien, M. S., DeWeese, J. A., Sumner, D. S., Aburahma, A., Turnipseed, W. D., & Dalsing, M. (1992). Natural history of recurrent and residual stenosis after carotid endarterectomy: Implications for postoperative surveillance and surgical management. Surgery, 112(4), 656-663.

Natural history of recurrent and residual stenosis after carotid endarterectomy : Implications for postoperative surveillance and surgical management. / Ricotta, J. J.; O'Brien, M. S.; DeWeese, J. A.; Sumner, D. S.; Aburahma, A.; Turnipseed, W. D.; Dalsing, Michael.

In: Surgery, Vol. 112, No. 4, 1992, p. 656-663.

Research output: Contribution to journalArticle

Ricotta, JJ, O'Brien, MS, DeWeese, JA, Sumner, DS, Aburahma, A, Turnipseed, WD & Dalsing, M 1992, 'Natural history of recurrent and residual stenosis after carotid endarterectomy: Implications for postoperative surveillance and surgical management', Surgery, vol. 112, no. 4, pp. 656-663.
Ricotta JJ, O'Brien MS, DeWeese JA, Sumner DS, Aburahma A, Turnipseed WD et al. Natural history of recurrent and residual stenosis after carotid endarterectomy: Implications for postoperative surveillance and surgical management. Surgery. 1992;112(4):656-663.
Ricotta, J. J. ; O'Brien, M. S. ; DeWeese, J. A. ; Sumner, D. S. ; Aburahma, A. ; Turnipseed, W. D. ; Dalsing, Michael. / Natural history of recurrent and residual stenosis after carotid endarterectomy : Implications for postoperative surveillance and surgical management. In: Surgery. 1992 ; Vol. 112, No. 4. pp. 656-663.
@article{913b7db442aa44cdb131c375948ae7fe,
title = "Natural history of recurrent and residual stenosis after carotid endarterectomy: Implications for postoperative surveillance and surgical management",
abstract = "Background. Noninvasive surveillance of patients after carotid endarterectomy is practiced routinely to detect recurrent stenoses. Many authors advocate repair of asymptomatic severe stenoses so detected. The likelihood of these lesions causing neurologic symptoms is unknown. Our aims were to (1) define the incidence of lesions, (2) determine the frequency of associated neurologic symptoms, and (3) identify patient-dependent factors that might predict restenosis. Methods. Data on the status of 449 carotid arteries after endarterectomy were reviewed. The number of recurrent and residual severe (≥80{\%}) stenoses was identified. Interval to development of symptoms was determined by life-table analysis. Patient-dependent factors (age, gender, smoking, diabetes, and patch closure) were evaluated by univariate and multivariate analysis to identify possible associations with severe lesions. Results. Severe (≥80{\%}) stenoses were seen in 35 patients (7.9{\%}). Residual lesions were seen in 17 cases (eight occlusions and nine stenoses); recurrent lesions were identified in 18 patients (3.9{\%}). Symptoms developed in five cases (14{\%}) (one residual and four recurrent) 35, 48, 68, 98, and 103 months after surgery. The likelihood of developing symptoms associated with stenosis at 5 years was 6{\%}. No factors correlated with residual stenosis. Age less than 60 years, female gender, primary closure, and absence of diabetes were more common in patients with recurrent lesions. Conclusions. Severe lesions can be found after carotid endarterectomy in at least 8{\%} of patients and consist of residual defects, as well as recurrent stenoses. Recurrent lesions are more common in specific patient subgroups. These lesions are stable for long periods and the majority remain asymptomatic. Operation is not indicated unless symptoms develop in these patients. Intraoperative completion evaluation may be indicated to reduce the incidence of residual disease. Early noninvasive evaluation is useful as a quality-control measure. Repeated surveillance may provide data on the course of restenosis or contralateral disease progression but is of limited clinical benefit.",
author = "Ricotta, {J. J.} and O'Brien, {M. S.} and DeWeese, {J. A.} and Sumner, {D. S.} and A. Aburahma and Turnipseed, {W. D.} and Michael Dalsing",
year = "1992",
language = "English (US)",
volume = "112",
pages = "656--663",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Natural history of recurrent and residual stenosis after carotid endarterectomy

T2 - Implications for postoperative surveillance and surgical management

AU - Ricotta, J. J.

AU - O'Brien, M. S.

AU - DeWeese, J. A.

AU - Sumner, D. S.

AU - Aburahma, A.

AU - Turnipseed, W. D.

AU - Dalsing, Michael

PY - 1992

Y1 - 1992

N2 - Background. Noninvasive surveillance of patients after carotid endarterectomy is practiced routinely to detect recurrent stenoses. Many authors advocate repair of asymptomatic severe stenoses so detected. The likelihood of these lesions causing neurologic symptoms is unknown. Our aims were to (1) define the incidence of lesions, (2) determine the frequency of associated neurologic symptoms, and (3) identify patient-dependent factors that might predict restenosis. Methods. Data on the status of 449 carotid arteries after endarterectomy were reviewed. The number of recurrent and residual severe (≥80%) stenoses was identified. Interval to development of symptoms was determined by life-table analysis. Patient-dependent factors (age, gender, smoking, diabetes, and patch closure) were evaluated by univariate and multivariate analysis to identify possible associations with severe lesions. Results. Severe (≥80%) stenoses were seen in 35 patients (7.9%). Residual lesions were seen in 17 cases (eight occlusions and nine stenoses); recurrent lesions were identified in 18 patients (3.9%). Symptoms developed in five cases (14%) (one residual and four recurrent) 35, 48, 68, 98, and 103 months after surgery. The likelihood of developing symptoms associated with stenosis at 5 years was 6%. No factors correlated with residual stenosis. Age less than 60 years, female gender, primary closure, and absence of diabetes were more common in patients with recurrent lesions. Conclusions. Severe lesions can be found after carotid endarterectomy in at least 8% of patients and consist of residual defects, as well as recurrent stenoses. Recurrent lesions are more common in specific patient subgroups. These lesions are stable for long periods and the majority remain asymptomatic. Operation is not indicated unless symptoms develop in these patients. Intraoperative completion evaluation may be indicated to reduce the incidence of residual disease. Early noninvasive evaluation is useful as a quality-control measure. Repeated surveillance may provide data on the course of restenosis or contralateral disease progression but is of limited clinical benefit.

AB - Background. Noninvasive surveillance of patients after carotid endarterectomy is practiced routinely to detect recurrent stenoses. Many authors advocate repair of asymptomatic severe stenoses so detected. The likelihood of these lesions causing neurologic symptoms is unknown. Our aims were to (1) define the incidence of lesions, (2) determine the frequency of associated neurologic symptoms, and (3) identify patient-dependent factors that might predict restenosis. Methods. Data on the status of 449 carotid arteries after endarterectomy were reviewed. The number of recurrent and residual severe (≥80%) stenoses was identified. Interval to development of symptoms was determined by life-table analysis. Patient-dependent factors (age, gender, smoking, diabetes, and patch closure) were evaluated by univariate and multivariate analysis to identify possible associations with severe lesions. Results. Severe (≥80%) stenoses were seen in 35 patients (7.9%). Residual lesions were seen in 17 cases (eight occlusions and nine stenoses); recurrent lesions were identified in 18 patients (3.9%). Symptoms developed in five cases (14%) (one residual and four recurrent) 35, 48, 68, 98, and 103 months after surgery. The likelihood of developing symptoms associated with stenosis at 5 years was 6%. No factors correlated with residual stenosis. Age less than 60 years, female gender, primary closure, and absence of diabetes were more common in patients with recurrent lesions. Conclusions. Severe lesions can be found after carotid endarterectomy in at least 8% of patients and consist of residual defects, as well as recurrent stenoses. Recurrent lesions are more common in specific patient subgroups. These lesions are stable for long periods and the majority remain asymptomatic. Operation is not indicated unless symptoms develop in these patients. Intraoperative completion evaluation may be indicated to reduce the incidence of residual disease. Early noninvasive evaluation is useful as a quality-control measure. Repeated surveillance may provide data on the course of restenosis or contralateral disease progression but is of limited clinical benefit.

UR - http://www.scopus.com/inward/record.url?scp=0026743978&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026743978&partnerID=8YFLogxK

M3 - Article

C2 - 1411935

AN - SCOPUS:0026743978

VL - 112

SP - 656

EP - 663

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 4

ER -